Bench Staff Registration (Raiders Hockey Club)


Print Bench Staff Registration
Please select the team you are associated with and your position on that team staff.
  1. Example: U12 Red
Please enter your name, date of birth and complete address.
  1. The name entered here must be the same as the name entered when registering for Certification Clinics
  2. RadDatePicker
    Open the calendar popup.
    mm/dd/yyyy Type the date in using this format or select from the calendar. Birthdate is required when registering a coach to a roster in the Hockey Canada Registry
  3. City Only, Please DO NOT include Province
Please list the email addresses and phone numbers you wish to share. We must have 1 email address and 1 phone number for communication purposes. You control what we make public for privacy reasons so please indicate which information, if any, that you would like to display in your team profile. A COPY OF THIS FORM WILL BE SENT TO PRIMARY EMAIL 1 AS CONFIRMATION OF YOUR SUBMISSION
  1. Example: yo[email protected]. Your submission will be sent to this address.
  2. Example: ###-###-####
  3. Example: ###-###-####
Please insert your current level of certification in each category if applicable. All team personnel must have PRS Certification.
  1. Please enter your HCR ID#
Police Check
Valid Police Checks must have an issue date after January 1, 2017
  1. RadDatePicker
    Open the calendar popup.
  2. Allowed extensions: .jpeg, .jpg, .png, gif, .pdf.
    Maximum # Files: 4. Maximum File Size: 4MB.
  1. Add comments here as to why a form has been edited and Re-Submitted
Human Validation